PERMIT NO. ______
COUNTY OF WAPELLO
STATE OF IOWA
APPLICATION FOR BUILDING PERMIT
PLEASE TYPE OR PRINT LEGIBLY
DATE OF APPLICATION: ______, 20______
APPLICANT:______
______, ______, ______, ______
(STREET ADDRESS)(CITY)(STATE)(ZIP)
PHONE: (_____)_____-______(_____)_____-______
HOMEBUSINESS
CURRENT PROPERTY OWNER:______
NEW ADDRESS INFORMATION
SEC: ______TWP: ______RANGE: _____STREET: ______
SIDE OF ROAD:NORTH: _____SOUTH: ______EAST: ______WEST: _____
NEW ADDRESS:______MAIL DISTRICT:______
CHECKED BY: ______DATE: ______
PROJECT ADDRESS: ______
USE CODE ______
1. NEW HOME (MANUFCATURED OR ON SITE)4. UTILITIES (RADIOTOWER, WATER TOWER, ECT.)7. STORAGEBUILDING
2. MOBILE HOME (SINGLE OR DOUBLE)5. ELECTRICAL8. MISCELLANEOUS
3. SHED / POLE BARN 6. ADDITION (HOME /OTHER)9. INDUSTRIAL
STRUCTURE DESCRIPTION
GENERAL CONTRACTOR: ______PHONE: ______
DEMOLISH EXISTING STRUCTURE □ NEW □ALTERATION □ADDITION □
NUMBER OF BEDROOMS: ______NUMBER OF FLOORS: ______above ground
LOT SIZE ______SIZE (STRUCTURE) ______ LENGTH X WIDTHHEIGHT: ______
USE OF BUILDING: ______
MANUFACTURED HOME: YEAR BUILT: ______MOBILE HOME: YEAR BUILT: ______
BASEMENT: Full □Partial □None □Finished □Unfinished □SIZE ______LENGTH X WIDTH
GARAGE: ATTACHED □DETACHED □SIZE ______LENGTH X WIDTH
USE OF BUILDING: ______
ELECTRICAL (REPAIR OR MAINTENANCE)
CLASS OF WORK: ADDITION □ALTERATION □MOVE □REMOVE □
ESTIMATED COST INCLUDING LABOR ______STATE LICENSED ______
CLASS NUMBER EXPIRATION
CONTRACTOR NAME: ______
DESCRIBE WORK BEING DONE______
______
PLUMBING (REPAIR OR MAINTENANCE)
CLASS OF WORK: ADDITION □ALTERATION □MOVE □REMOVE □
ESTIMATED COST INCLUDING LABOR ______
DESCRIBE WORK BEING DONE______
______
MECHANICAL (REPAIR OR MAINTENANCE)
CLASS OF WORK: ADDITION □ALTERATION □MOVE □REMOVE □
ESTIMATED COST INCLUDING LABOR ______
DESCRIBE WORK BEING DONE______
______
PERMIT FEES
SUBDIVISION: ______HOME OCCUPATION PERMIT: ______RV PERMIT: ______
SPECIAL USE: ______ON-SITE WASTEWATER: ______PERK TEST: ______
MECHANICAL: ______ELECTRICAL: ______PLUMBING: ______
BUILDING PERMIT: ______
TOTAL FEES: ______
NOTICE: This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended or abandoned for a period of 180 days at any time after work is commenced.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not, the granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction.
The undersigned applicant certifies that the foregoing information is true and correct to the best of their ability and knowledge. By signing, the owner herby gives Wapello County permission to enter upon premises to perform all inspections required under Chapter 43, Wapello County Construction Codes.
An Occupancy Permit MUST be issued before applicant is allowed to use or occupy building/structure. A $100.00 re-inspection fee will be charged for violating the Wapello County Construction Code and the current IRC.
DATE: ______
APPLICANT
DATE: ______
OWNER OR LEGAL AUTHORIZED REPRESENTATIVE
APPROVED BY BUILDING OFFICIAL
DATE: ______